Made available in DSpace on 2014-06-11T19:31:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-10-21Bitstream added on 2014-06-13T20:22:01Z : No. of bitstreams: 1 ferreira_fpp_dr_botfmvz.pdf: 755955 bytes, checksum: 4fe3653cb861fb0413e91dbf3dda18bc (MD5) / Universidade Estadual Paulista (UNESP) / O advento da cirurgia laparoscópica em equinos possibilitou uma abordagem minimamente invasiva da cavidade abdominal, sendo atualmente muito importante no auxílio ao diagnóstico e tratamento das afecções do trato digestório, urinário e reprodutor. O presente estudo teve como objetivos; avaliar a técnica cirúrgica de implantação videoassistida de uma sonda no ceco, relatar as alterações clinico laboratoriais inerentes a implantação da sonda intracecal. Para a realização deste experimento foram utilizados oito equinos hígidos, adultos, machos e fêmeas, que foram submetidos a um período de jejum – hídrico e alimentar – de 96 horas, recebendo apenas a hidratação enteral por via intracecal. Os animais foram avaliados clinica e laboratorialmente a cada 24 horas. A solução hidratante foi constituída de 5,7 g de Cloreto de Sódio, 3,78 g de Bicarbonato de Sódio, e 0,37 g de Cloreto de Potássio por litro de água administrado de forma contínua, na base de 50 ml/kg de peso. Ao final do experimento pudemos constatar que a técnica de implantação videoassistida da sonda intracecal é viável / The advent of laparoscopic surgery in horses allowed a minimally invasive abdominal cavity, and is currently very important for the diagnosis and treatment of diseases of the digestive tract, urinary and reproductive systems. This study aimed to evaluate the surgical technique of video-assisted implantation of a probe into the cecum, to report the changes inherent in the clinical laboratory application of the probe and the viability of this route for the administration of enteral fluid. For this experiment used eight horses they were healthy, adult male and female, which underwent a period of fasting for 96 hours, receiving only hydration through enteral intracecal. The animals were evaluated clinically and laboratory every 24 hours. The hydrating solution consisted of 5.7 g sodium chloride, 3.78 g of sodium bicarbonate, and 0.37 g of potassium chloride per liter of water administered continuously, on the basis of 50 ml / kg weight. At the end of the experiment, we confirmed that the surgical technique of video-assisted implantation of the probe is feasible

Orientador: Wilter Ricardo Russiano Vicente / Banca: José Antonio Marques / Banca: Carlos Eduardo Bezerra de Moura / Resumo: A castração de fêmeas se mostra importante na produção animal. Porém, existem poucas técnicas de ovariectomia descritas em pequenos ruminantes. Desta forma, objetiva-se com o presente estudo propor técnicas alternativas por videolaparoscopia e avaliá-las quanto ao desconforto doloroso dos animais e consequentemente queda na produção, viabilidade e tempo de execução. Sendo assim, primeiramente descreveu-se e comparou-se a ovariectomia por laparotomia (OL), vídeo-assistida (OVA) e total vídeolaparoscópica (OTV) em ovelhas da raça Santa Inês adultas, avaliando o trans e pós-cirúrgico, e verificando o estresse causado às fêmeas por cada procedimento. Já em um segundo momento objetivou-se desenvolver e descrever uma técnica de ovariectomia por videolaparoscopia utilizando um portal laparoscópico e um sistema de ligadura pré-montada (OTVM), avaliando a sua viabilidade, o desconforto doloroso e o processo inflamatório provocado em ovelhas da mesma raça. Concluiu-se então que as técnicas OVA e OTV apresentaram grande vantagem em relação a OL por serem processos minimamente invasivos, de rápida realização e que proporcionam mínimo desconforto e ótima recuperação das ovelhas, sendo recomendado por causar mínimo estresse e decréscimo na produção animal. E que a OTVM foi viável e exeqüível para a espécie ovina, não provocando também hemorragias, estresse, desconforto doloroso e perda de peso nos animais, apesar do tempo cirúrgico ter sido maior que nas outras técnicas laparoscópicas / Abstract: The castration of females is important in animal production. However, there are few techniques of ovariectomy described in small ruminants. Thus, the aim of this study was propose alternative techniques of ovariectomy by laparoscopy and evaluate the painful discomfort of the animals and consequently decrease in production, the feasibility and execution time. Therefore, at a first moment was described and compared the ovariectomy by laparotomy (OL), video-assisted (OVA) and total laparoscopic (OTV) in Santa Ines adult ewes, evaluating the transoperative and postoperative, and the stress caused to females for each procedure. In a second moment, aimed to develop and describe a technique for ovariectomy by laparoscopy using one portal and a ligation system pre-assembled (OTVM), evaluating their feasibility, the painful discomfort and the inflammatory process caused in ewes in the same breed. It was concluded that the OVA and OTV techniques had a great advantage compared to OL, once they are minimally invasive procedures, of rapid implementation and provide a minimal discomfort and great recovery of ewes, being recommended since they cause a minimal stress and decrease in animal production. The OTVM was viably and feasibly to the ovine species, not causing bleeding, stress, painful discomfort and weight loss in animals, although the surgical time have been greater than in other laparoscopic techniques / Mestre

Laparoscopic femoral herniorrhaphy using a preperitoneal plug and patch appears to be a feasible laparoscopic approach to femoral hernia. A modified preperitoneal femoral hernia repair with mesh and resection of incarcerated small bowel has been successfully completed under laparoscopic guidance in a 64-year-old patient with incarcerated femoral hernia. To our knowledge, this is the first such case reported in the United States. With further experience, laparoscopic femoral herniorrhaphy could provide a viable alter-native to the standard treatment of femoral hernia.

Objective - To evaluate a surgical technique for performing laparoscopic bilateral ovariectomy in standing horses. Study Design - Experimental study. Animals or Sample population - 8 mares, age 2-20 years, weight 410-540 kg. Methods - Standing laparoscopic bilateral ovariectomy was performed in 8 mares with normal anatomy of the reproductive tract. The Harmonic Scalpel (an ultrasonically activated instrument) was used to transect the ovarian pedicle and to obtain hemostasis simultaneously. Necropsy was performed on 4 mares 3 days after surgery and 30 days following surgery on the remaining 4 mares. Gross and histopathologic evaluation of the ovarian pedicles was performed to characterize the effects of the Harmonic Scalpel on the transected tissue. Results - The Harmonic Scalpel achieved complete hemostasis of the vasculature of the ovarian pedicles in all mares. Median transection time for the ovarian pedicle was 28 minutes. Postoperative complications included transient fever in one mare, moderate subcutaneous emphysema in another, and incisional seroma formation in a third mare. Post-mortem examination 3 and 30 days postoperatively revealed no signs of generalized peritonitis, postoperative hemorrhage or adhesion formation. Mild to moderate acute inflammation, and scar formation with moderate chronic inflammation at the ovarian pedicle was found 3 and 30 days after surgery, respectively. Median depth of coagulation necrosis 3 days postoperatively was 2.87 mm. Conclusions - The Harmonic Scalpel appears to provide reliable hemostasis of the ovarian pedicle during elective laparoscopic ovariectomy in horses. Clinical Relevance - The Harmonic Scalpel represents a safe alternative to other means of hemostasis during elective laparoscopic ovariectomy in horses. / Master of Science

A laparoscopia em equinos para a realização de castração de criptorquídicos, herniorrafia inguinal, biópsias teciduais, ovariectomia e exploração abdominal são procedimentos freqüentes na medicina veterinária atualmente e muitas vezes, requerem anestesia geral. Para tanto, há a necessidade do posicionamento do animal com inclinação da cabeça para baixo e elevação da pelve (posição de Trendelenburg) e a insuflação de dióxido de carbono (CO2) sob pressão na cavidade abdominal, pois este procedimento facilita a visualização dos órgãos abdominais pelo cirurgião. Este técnica pode promover diversas alterações sistêmicas no animal, principalmente em relação à hemodinâmica, oxigenação e mecânica respiratória. O objetivo este estudo foi avaliar os efeitos da insuflação abdominal com CO2 e a posição de Trendelenburg sobre a mecânica respiratória, hemodinâmicas central e periférica, oxigenação e marcadores inflamatórios sistêmicos em equinos adultos, submetidos à ventilação controlada associada à pressão positiva no final da expiração (PEEP). Para tanto foram utilizados 8 equinos, sendo 7 machos e 1 fêmea, pesando 367 ±56 Kg. Os animais foram medicados com MPA, seguida de indução anestésica e anestesia inalatória com isoflurano. Após o período de instrumentação foi realizada uma manobra de recrutamento alveolar, instituição do pneumoperitônio de 8 mmHg e inclinação da mesa cirúrgica em 25° por 60 minutos. Os parâmetros foram avaliados após a manobra de recrutamento alveolar, 10 e 60 minutos após a inclinação da mesa e 30 minutos após o retorno ao decúbito dorsal. Durante o período em que os animais permaneceram em Trendelenburg houve aumento significativo de PAP, POAP, PVC, IRVS, IRVP e IS. O mesmo ocorreu com as pressões de pico e de platô e com a resistência. Ao longo deste mesmo período houve ainda diminuição da fração PaO2/FiO2, aumento da diferença de conteúdo arteriovenoso de oxigênio e aumento da taxa de extração de oxigênio. Em relação aos valores de IL- 1Ra, IL-10 e TNFα não houve diferença entre aqueles obtidos antes e depois do procedimento experimental. / Laparoscopic surgeries in horses to perform castration of cryptorchid, tissue biopsies and ovariectomy are common and often require general anesthesia. In addition, there is the need for placement the animal with head tilt and elevation of pelvis (Trendelenburg) and insufflation of carbon dioxide (CO2) under pressure in abdominal cavity. This study aimed to evaluate changes in mechanical ventilation, systemic inflammatory response as well as hemodynamic changes and oxygenation values in horses during surgery in Trendelenburg position. The studied population consisted of 8 horses, weighting 367±56 kg. The animals were kept under general anesthesia in dorsal recumbency, with 8 mmHg capnoperitonium and tilted at 25° for 60 minutes. During a preliminary stabilization period the horses were instrumented for monitoring and data collection. The mechanical ventilation was performed with controlled volume and positive end-expiratory pressure (PEEP). Before placing the animal in Trendelemburg position one recruitment maneuver was performed. All data were recorded at 10 and 60 minutes after tilting the animal and after 30 minutes it has been placed back in dorsal recumbency. There was a significant variation of PAP, OPPA, CVP, SVRI and PVRI before and after the tilted position. There was also increase in inspiratory pick pressure, plateau pressure and expired CO2. The static compliance decreased 32%, followed by enhancement of PaCO2 from 53 to 72 mmHg until the end of Trendelemburg. The PaO2/FiO2 ratio reduced 37% followed by decrease in oxygen saturation. The ventilation strategy associated with procedure did not promote enhancement of plasmatic concentrations of IL-10, IL- 1Ra, and TNFα.

As doenças do trato digestório nos equinos apresentam altas taxas de morbidade e mortalidade, com diferentes etiologias. Em alguns casos, o emprego da biopsia intestinal se faz necessário para auxílio no diagnóstico dessas enfermidades. No entanto, as técnicas convencionais podem trazer riscos aos pacientes, por serem invasivas, ou não serem elucidativas por apresentarem limitações de acesso a determinados segmentos. O presente estudo teve como objetivo validar uma técnica de biopsia intestinal, intracorpórea, assistida por videolaparoscopia, ainda não descrita na literatura, para coleta de fragmentos de mucosa de jejuno e cólon menor de equinos, que sejam considerados adequados para avaliação histológica. Para tanto, foram utilizados seis equinos machos, da raça Puro Sangue Árabe, com idade de dois anos, sem histórico prévio de doenças do trato digestório, com peso médio de 267 kg. Todos os animais foram submetidos ao mesmo procedimento laparoscópico, instituindo-se apenas jejum alimentar prévio de oito horas. Os equinos foram acompanhados com exame físico e de ultrassonografia abdominal, desde o dia precedente às laparoscopias, até o 15º dia do período pós-operatório, bem como avaliados por meio de hemograma, provas de funções hepática e renal, e análise do líquido peritoneal nos dias 0, 1, 2, 3, 5, 7, 10, 14, 21 e 30. O tempo cirúrgico foi cronometrado, sendo registrado o tempo total, iniciado na criação do primeiro portal de acesso e finalizado ao término da sutura de pele, e os tempos parciais para biopsia de jejuno e cólon menor separadamente, com início na apreensão do segmento intestinal e término quando constatada a polimerização da cola cirúrgica sobre o orifício de acesso da agulha. De cada segmento obtiveram-se dez fragmentos, e posteriormente submetidos à análise histológica. Atribuiu-se escore para cada um deles, sendo considerado 0 fragmentos com qualidade ruim; 1 para qualidade boa e 2 para qualidade ótima. Por sua vez, os considerados viáveis foram somente os que se enquadraram nos escores 1 e 2. Amostras avaliadas como adequadas 11 apresentaram no mínimo 50% dos fragmentos viáveis. A média do tempo total de procedimento foi de 66,50 minutos (± 7,87), enquanto a média do tempo parcial para biopsia de jejuno foi de 14,2 minutos (± 4,3) e a de cólon menor 12,7 minutos (± 5,0). Clinicamente, os animais apresentaram desconforto abdominal nas primeiras 48 horas. Os exames ultrassonográficos do abdômen não revelaram alterações condizentes com peritonite ao longo de todo experimento. Os parâmetros laboratoriais apresentaram apenas características inflamatórias, sendo que o líquido peritoneal permaneceu alterado até o 21º de pós-operatório, havendo normalização de todos os seus valores no 30º dia do estudo. Na inspeção laparoscópica de dois equinos (E2, E4) foi identificada aderência de porção de omento no diafragma. Nas avaliações histológicas de jejuno, uma amostra (E5) de seis foi considerada inadequada, com 5/12 fragmentos viáveis, e em cólon menor, duas (E1, E2) de seis, foram inadequadas, com 4/9 e 5/10 fragmentos viáveis respectivamente. A nova técnica de biopsia intestinal possibilitou a coleta de amostras adequadas de mucosa para análise histológica, de forma segura para os animais, uma vez que as alterações clínicas e laboratoriais foram aquelas relacionadas ao processo inflamatório, compatível com procedimentos laparoscópicos na espécie / Gastrointestinal diseases in horses result in high rates of morbidity and mortality, with different aetiologies. In some cases, an intestinal biopsy is needed to aid in the diagnosis of such diseases. However, the conventional techniques can pose risks to patients for being invasive or for not being elucidating due to having limitations in accessing certain segments. The objective of this study was to validate an intestinal biopsy technique, intracorporeal, assisted by laparoscopy, which has not yet been described in the literature, to collect mucosal fragments from the jejuno and small colon, which might be considered suitable for histological assessment. For such, six male horses were used, Arabian breed, with two years of age, without any records of abdominal diseases, weighing 267 kg in average. All horses were subjected to the same laparoscopic procedure, fasting for eight hours previously to the procedure. All horses were monitored through physical examination and abdominal ultrasonography, from the day previous to laparoscopy, until the 15th postoperative day, as well as hemogram, tests of liver and kidney functions, and analysis of the peritoneal fluid in days 0, 1, 2, 3, 5, 7, 10, 14, 21 and 30. The total laparoscopic procedure time was registered, starting at the moment of the first incision and ending at the moment of the skin closure. The partial times for the jejunal biopsy and small colon biopsy were recorded as well, starting at the grasping of the intestinal segment and ending at the moment of polymerization of the surgical adhesive on the needle access site. From each segment, ten fragments were collected and later subjected to histological analysis. A score was assigned for each one of them, being scored \"0\" fragments of poor quality; \"1\" fragments of good quality and \"2\" fragments of optimal quality. The samples considered viable were only the ones which scored 1 and 2. The samples deemed as adequate showed at least 50% of it fragments to be viable. The average of the surgery total time was of 66,50 minutes (± 7.87), whereas the average of the jejunal biopsy was of 14.2 minutes (± 4.3) and the small colon biopsy time was of 12.7 minutes ( ± 5.0). Clinically, the animals showed mild abdominal 13 discomfort in the first 48 hours. Ultrasonographic examination of the abdomen did not reveal any alterations consistent with peritonitis throughout the entire experiment period. Laboratory parameters presented inflammatory characteristics, and the peritoneal fluid remained altered until the 21th postoperative day, with normalization of all its values on the 30th day of the study. During the laparoscopic inspection of two horses (E2, E4) was identified partial omental adhesion with the diaphragm. In the jejunal histological evaluations, one sample (E5) of six was considered inadequate, with 5/12 viable fragments, and as for the small colon, two (E1, E2) of six were inadequate, with 4/9 and 5/10 viable fragments respectively. The new technique proposed allowed a safe collection of adequate mucosal samples for histological analysis, since clinical and laboratory abnormalities identified were related to the inflammatory process associated to the laparoscopic techniques in horses

Foram utilizados 10 eqüinos clinicamente sadios, machos, adultos, de diferentes raças, pesando entre 350 e 450 Kg, escolhidos aleatoriamente e divididos em dois grupos: em cinco animais foi realizada biópsia renal guiada por laparoscopia com agulha descartável do tipo tru-cut, e nos outros cinco através de pinça de biópsia laparoscópica de 5mm. Os procedimentos foram efetuados com os animais em posição quadrupedal, mediante sedação e analgesia, e bloqueio anestésico local em 2 pontos no flanco esquerdo, sendo um para introdução do trocarte e óptica, e outro para introdução da agulha ou pinça. Parâmetros clínicos e laboratoriais foram avaliados dois dias antes do procedimento e acompanhados nas três semanas subseqüentes, permitindo determinar as alterações decorrentes. As técnicas foram comparadas quanto à segurança, qualidade, tempo de execução e significância da amostra colhida. Durante o acompanhamento pós-operatório dos animais, não houve variação clínica e laboratorial significativa em ambos os grupos, porém, a análise histológica dos fragmentos demonstrou uma maior porcentagem de biópsias adequadas no grupo em que foi utilizada pinça laparoscópica. / Ten healthy adult male horses, of different breeds, weighing between 350 and 450kg were randomly chosen and divided into two groups of five animais each: in one group, laparoscopic guided renal biopsy was pertormed using tru-cut needles and in the other group using 5mm forceps. Procedures were carried out with animais in quadrupedal position, under sedation and analgesia and local anesthetic nerve block was made in two points on the left flank: one for the introduction of the trocar and optical system and one for the introduction of the needle or forceps. Laboratory and clinical parameters were evaluated two days prior to the proceeding and followed up in the subsequent three weeks in order to verify the resulting alterations. The techniques were compared as regards safety, quality, time for execution and significance of the sample obtained. During the post-surgery follow-up period, no significant clinical and laboratory alterations were observed in either group, although the histological analysis of the fragments a higher percentage of adequate biopsies in the group where Laparoscopic forceps were used.

As hérnias inguino-escrotais afetam principalmente equinos machos, sendo caracterizadas como diretas ou indiretas e congênitas ou adquiridas. O emprego da laparoscopia para o fechamento do anel vaginal permite a fixação de implantes e retalhos peritoneais para recobrir a entrada do canal inguinal. As membranas biológicas empregadas como enxerto tecidual apresentam vantagens como baixo custo, fácil armazenamento, pouca reação tecidual, boa incorporação, elasticidade e resistência. Este estudo teve como objetivo avaliar a fixação e a presença do implante de pericárdio homólogo em anel vaginal de equino, realizado por sutura laparoscópica mecânica ou manual por um período de 11 semanas. Neste estudo foram utilizados seis equinos, machos inteiros, da raça Mangalarga, entre três e 12 anos, submetidos à anestesia inalatória, posicionados em Trendelenburg com elevação de 25 º da porção pélvica. Foram criados cinco portais, sendo um na cicatriz umbilical para entrada do laparoscópio e dois portais em cada hemi-abdômem, para acesso dos instrumentais. Em cada animal fixaram-se dois implantes de pericárdio, com medidas de 4 x 5 cm. Em um dos anéis a fixação foi realizada através de sutura manual e no contralateral por sutura mecânica. Avaliou-se o tempo cirúrgico, eventuais complicações, custo, eficiência, processo inflamatório e cicatrização. O tempo necessário para a realização da sutura manual em padrão contínuo simples foi em média 4,7 vezes maior (P > 0,05) que na sutura mecânica, apesar do tempo de sutura manual corresponder a apenas 40% do tempo total do procedimento. Porém, a sutura manual apresentou melhor ancoragem e estabilidade do implante quando comparado com a fixação mecânica. A fixação com endogrampeador aumentou em 50 % o custo total do procedimento quando comparado à sutura manual. Na avaliação macroscópica todos os implantes foram recobertos por tecido cicatricial, apresentando coloração esbranquiçada, difícil delimitação das margens e incorporação do implante pelo peritônio parietal. Os seis implantes fixados com sutura manual permaneceram no local, com boa oclusão do anel vaginal, sendo que em dois foi visualizada, aderência de epíplon e em outro uma sinéquia entre a cicatriz inguinal e o colón maior. Em dois dos seis implantes fixados por sutura mecânica ocorreu deiscência parcial, ocasionando migração de uma das margens e oclusão incompleta do anel vaginal. Uma aderência de epíplon foi observada no implante fixado por grampeamento. O líquido peritoneal no pós-operatório apresentou coloração avermelhada, aspecto turvo e alta celularidade, com diferença significativa (P >0,05), sendo basicamente neutrófilos. Essas alterações diminuíram gradativamente até a quarta semana quando os valores apresentaram-se normais para a espécie. Na avaliação histológica os implantes fixados pelos dois tipos de sutura apresentaram alterações similares, sendo identificado tecido cicatricial em fase de remodelação com moderado infiltrado de células mononucleares, apresentando discreta neovascularização e intensa fibroplasia. O uso de pericárdio homólogo para recobrimento do anel vaginal de equino, fixado através de sutura laparoscópica, manual ou mecânica, proporcionou oclusão satisfatória do anel vaginal, com vantagem para o uso de sutura manual quanto à fixação e custo e para a sutura mecânica quanto ao tempo operatório. / The inguinal hernias affect mainly equine males, being classified as direct or indirect and congenital or acquired. The use of laparoscopy for vaginal ring closure allows the fixation of implants and peritoneal flaps to recover the vaginal canal. The biological membranes employed like flap tissue present advantages such as low cost, easy storage, mild reaction tissue, complete incorporation, elasticity and resistance. The aim of this study was to evaluate the homologous pericardium implanted at equine vaginal ring, carried out by mechanical or manual laparoscopic suture during and after a period of 11 weeks. Six males Mangalarga breed horses between three and 12 years old were used. They underwent general anesthesia, positioned in Trendelenburg with elevation of 25 º of the pelvic region. Five laparoscopic portals were created, one being in the umbilical scar for the entry of the laparoscope and two in each hemi-abdomen for access of the laparoscopic instruments. On each horse two pericardium implants measuring 4 x 5 cm were attached at the vaginal ring regions. In one of the rings the fixation was carried out through manual suture and the contra lateral using mechanical suture. The surgical time, complications, costs, efficiency, inflammatory response and healing were evaluated. The time to carry out the manual suture was 4,7 times longer (P> 0,05) than the mechanical suture. The time for manual suture execution was 40 % of the total time spent for the surgical and anesthetic procedures. However, the manual suture presented better anchorage and stability of the implant when compared with the mechanical fixation. The fixation with intracorporeal staples increased the total cost of the procedure in 50 % when compared to the manual suture. All the implants were covered and incorporated by scar tissue presenting whitish color, without graft definition. Six implants attached by manual suture remained at the place with adequate occlusion of the vaginal ring, and in two of them epiplon adhesions was visualized and in other one a synechia was identified between the inguinal scar and the large colon. In two of six implants attached by mechanical suture, partial dehiscence was occurred, as a result of implant migration and incomplete occlusion of the vaginal ring. An epiplon adhesion was observed in the implant attached by intracorporeal staple. The peritoneal fluid presented changes in color (reddish), aspect (turbidity) and cellularity with significant difference (P> 0, 05), being basically neutrophils. These changes reduced gradually up to the normal values at the fourth week. In the histological evaluation of the implants attached using both types of sutures the aspects were similar presenting healing in remodeling phase with moderate mononuclear cells infiltration, mild neovascularization and intense fibroplasia. The use of homologous pericardium for equine vaginal ring covering, attached by laparoscopic suture, manual or mechanical, provided satisfactory occlusion of the vaginal ring with advantage for the manual suture relative to efficiency and cost and for the mechanical suture relative to reduced surgical time.

Laparoscopic surgery for colorectal cancer was first reported in 1991. However, early experiences with laparoscopic colectomy were unfavorable, with higher than expected rates of port-site recurrence and concerns about compromised long-term oncologic outcomes. These concerns have been resolved by the results of several large-scale European and American multicenter randomized controlled trials (RCTs) that reported no difference in oncologic clearance and survival between laparoscopic and open colectomy for colon cancer. / The role of laparoscopic surgery for rectal cancer, on the other hand, still remains controversial. Because laparoscopic surgery for rectal cancer is technically more difficult and has a higher morbidity rate than laparoscopic colectomy for colon cancer, most of the published large-scale multicenter RCTs comparing laparoscopic and open colorectal cancer did not include patients with rectal cancer. To date, good-quality data comparing laparoscopic and open surgery for rectal cancer are still scarce in the literature. The main objective of this thesis is to provide additional evidence to justify the role of laparoscopic surgery for rectal cancer. / To be justified, laparoscopic surgery for rectal cancer should have equal or better clinical outcomes than open surgery and improve quality of life. Furthermore, oncologic clearance as well as long-term survival should not be adversely affected by the laparoscopic approach. / In this thesis, a series of RCTs and comparative studies with long-term follow-up were conducted to address the above issues. Our results demonstrate that laparoscopic surgery for rectal cancer is associated with earlier postoperative recovery, better preservation of urosexual function and quality of life, and less late morbidity when compared with open surgery. Oncologic clearance in terms of resection margins and number of lymph nodes harvested are comparable between the laparoscopic and open groups. Most importantly, laparoscopic surgery does not adversely affect disease control or jeopardize long-term survival of rectal cancer patients. The benefits of the laparoscopic over the open approach remain the same regardless of the types of rectal cancer surgery (laparoscopic-assisted anterior resection, total mesorectal excision, or abdominoperineal resection) or the location of the tumor. It is therefore concluded that laparoscopic surgery for rectal cancer is safe and justified. Based on our results, we believe that laparoscopic surgery can be regarded as an acceptable alternative to open surgery for treating curable rectal cancer. / Ng, Siu Man Simon. / Thesis (M.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 323-366). / Dedication --- p.1 / Declaration of Originality --- p.2 / Abstract --- p.3 / Table of Contents --- p.5 / List of Tables --- p.8 / List of Figures --- p.10 / List of Abbreviations --- p.13 / PRÉCIS TO THE THESIS --- p.15 / Chapter PART I --- BACKGROUND --- p.37 / Chapter Chapter 1 --- Management of Colorectal Cancer: From Open to Laparoscopic Surgery --- p.38 / Chapter 1.1 --- Introduction to Colorectal Cancer --- p.39 / Chapter 1.2 --- A Brief History of Laparoscopic Surgery --- p.51 / Chapter 1.3 --- Laparoscopic Colorectal Surgery: The Beginning --- p.58 / Chapter 1.4 --- Evidence for the Safety and Efficacy of Laparoscopic Surgery for Colon Cancer --- p.62 / Chapter Chapter 2 --- Laparoscopic Surgery for Rectal Cancer: A Critical Appraisal of Published Literature --- p.71 / Chapter 2.1 --- Introduction --- p.72 / Chapter 2.2 --- Evidence from Single-Center Trials --- p.76 / Chapter 2.3 --- Evidence from Multicenter Trials --- p.82 / Chapter 2.4 --- Ongoing Trials --- p.89 / Chapter 2.5 --- Discussion --- p.92 / Chapter Chapter 3 --- Laparoscopic Surgery for Rectosigmoid and Rectal Cancer: Experience at The Prince of Wales Hospital, Hong Kong --- p.97 / Chapter 3.1 --- The Beginning of Laparoscopic Era in Hong Kong --- p.98 / Chapter 3.2 --- Early Experience of Laparoscopic Colorectal Surgery --- p.102 / Chapter 3.3 --- Nonrandomized Comparative Studies --- p.105 / Chapter 3.4 --- The Hong Kong Trial --- p.110 / Chapter PART II --- HYPOTHESES AND CLINICAL STUDIES --- p.116 / Chapter Chapter 4 --- Research Hypotheses and Objectives --- p.117 / Chapter 4.1 --- Research Hypotheses --- p.118 / Chapter 4.2 --- Research Plan and Objectives --- p.120 / Chapter Chapter 5 --- Laparoscopic-Assisted Versus Open Anterior Resection for Upper Rectal Cancer: Short-Term Outcomes --- p.122 / Chapter 5.1 --- Abstract --- p.123 / Chapter 5.2 --- Introduction --- p.125 / Chapter 5.3 --- Patients and Methods --- p.128 / Chapter 5.4 --- Results --- p.133 / Chapter 5.5 --- Discussion --- p.144 / Chapter 5.6 --- Conclusions --- p.148 / Chapter Chapter 6 --- Laparoscopic-Assisted Versus Open Anterior Resection for Upper Rectal Cancer: Long-Term Morbidity and Oncologic Outcomes --- p.149 / Chapter 6.1 --- Abstract --- p.150 / Chapter 6.2 --- Introduction --- p.152 / Chapter 6.3 --- Patients and Methods --- p.154 / Chapter 6.4 --- Results --- p.158 / Chapter 6.5 --- Discussion --- p.173 / Chapter 6.6 --- Conclusions --- p.179 / Chapter Chapter 7 --- Laparoscopic-Assisted Versus Open Abdominoperineal Resection for Low Rectal Cancer --- p.180 / Chapter 7.1 --- Abstract --- p.181 / Chapter 7.2 --- Introduction --- p.183 / Chapter 7.3 --- Patients and Methods --- p.185 / Chapter 7.4 --- Results --- p.190 / Chapter 7.5 --- Discussion --- p.201 / Chapter 7.6 --- Conclusions --- p.207 / Chapter Chapter 8 --- Laparoscopic-Assisted Versus Open Total Mesorectal Excision with Anal Sphincter Preservation for Mid and Low Rectal Cancer --- p.208 / Chapter 8.1 --- Abstract --- p.209 / Chapter 8.2 --- Introduction --- p.211 / Chapter 8.3 --- Patients and Methods --- p.214 / Chapter 8.4 --- Results --- p.221 / Chapter 8.5 --- Discussion --- p.238 / Chapter 8.6 --- Conclusions --- p.246 / Chapter Chapter 9 --- Long-Term Oncologic Outcomes of Laparoscopic Versus Open Surgery for Rectal Cancer: A Pooled Analysis of Three Randomized Controlled Trials --- p.247 / Chapter 9.1 --- Abstract --- p.248 / Chapter 9.2 --- Introduction --- p.250 / Chapter 9.3 --- Patients and Methods --- p.254 / Chapter 9.4 --- Results --- p.258 / Chapter 9.5 --- Discussion --- p.272 / Chapter 9.6 --- Conclusions --- p.280 / Chapter Chapter 10 --- Prospective Comparison of Quality of Life Outcomes After Curative Laparoscopic Versus Open Sphincter-Preserving Resection for Rectal Cancer --- p.281 / Chapter 10.1 --- Abstract --- p.282 / Chapter 10.2 --- Introduction --- p.284 / Chapter 10.3 --- Patients and Methods --- p.287 / Chapter 10.4 --- Results --- p.292 / Chapter 10.5 --- Discussion --- p.308 / Chapter Chapter 11 --- Conclusions --- p.314 / Chapter 11.1 --- Conclusions --- p.315 / REFERENCES --- p.322 / LIST OF PUBLICATIONS RELATED TO THE THESIS --- p.367 / ACKNOWLEDGEMENTS --- p.373

Colorectal cancer is one of the commonest malignancies worldwide. Its prevention, diagnosis and treatments have attracted multidisciplinary attention. Surgery is the mainstay of treatment for colorectal cancer. It was estimated that up to 85% of colorectal cancer were amenable to surgical treatment, whether curative or palliative. Not surprisingly laparoscopic resection of colorectal cancer was reported soon after cholecystectomy. However, with the appearance of early port site recurrence, most authorities were concerned about the adequacy of tumour clearance and the long-term survival after laparoscopic resection. / In this thesis, comparative and randomized studies were conducted to answer the above questions. It was concluded that, as compared to conventional open surgery, laparoscopic assisted resection of recto-sigmoid carcinoma was less painful and allowed earlier post-operative recovery. Tissue trauma, as reflected by systemic cytokines response, was less after laparoscopic assisted resection. Some cellular components of immune system were also less suppressed. Most importantly, laparoscopic resection did not jeopardize the survival and disease control of patients. The justification of adopting laparoscopic technique would depend on the societal value of its effectiveness in improving the short-term post-operative outcomes. / Laparoscopic technology and its application may be the biggest advancement in nearly all surgical specialties in the last decade. Since the introduction of laparoscopic cholecystectomy, enthusiastic surgeons have attempted laparoscopic approach in almost every type of operations, and many of the techniques have gained public acceptance within a very short time. However, most of these developments were not based on good scientific evidence from comparative study. While laparoscopic cholecystectomy was shown to cause less pain and allow patients to recover earlier after operation, these benefits may or may not be conferred to other procedures and diseases. / Therefore, to justify the use of laparoscopic assisted colorectal resection for carcinoma, two criteria must be satisfied. Firstly the long term survival and the disease free interval of patients should not be adversely affected, as these are the most important endpoints in the success of tumour surgery. Secondly, the proposed benefits of minimally invasive surgery must be demonstrated, otherwise it is not worthwhile to adopt a new technique. / Leung Ka Lau. / "July 2005." / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0174. / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 122-155). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.